What does this research mean for the field?

Vasectomy demand has increased nearly tenfold over an eight-year period, and while procedural effectiveness is highly successful, patient adherence to post-vasectomy semen analysis remains modest at 65.3%. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to analyze trends in vasectomy demand, adherence to post-vasectomy semen analysis, and procedural success over eight years.

June 6, 2026

(710) Trends in Vasectomy Demand, Post-Vasectomy Semen Analysis Adherence, and Procedural Outcomes: An Eight-Year Experience at a Tertiary Center

Key Points

This research aims to analyze trends in vasectomy demand, adherence to post-vasectomy semen analysis, and procedural success over eight years.
Conducted a retrospective cohort study of vasectomies from January 2017 to April 2025 at a tertiary center.
Retrieved data from operating-room logs, electronic medical records, and fertility laboratory databases.
Primary outcome was defined as vasectomy success at first or repeat post-vasectomy semen analysis, requiring azoospermia or ≤100,000 non-motile sperm.
430 vasectomies performed with a substantial increase in annual volumes, peaking at 181 in 2024.
PVSA adherence was at 65.3%, with a median time of 104 days to first analysis.
97.5% had successful outcomes at first PVSA, demonstrating high procedural effectiveness but modest patient compliance.

Abstract

Abstract Introduction Vasectomy is a safe, effective, and increasingly sought-after method of permanent contraception. Recent surges in vasectomy rates have reignited debate regarding the real-world utility of post-vasectomy semen analysis (PVSA). While several studies report low adherence and question multi-sample testing protocols, guidelines still recommend clearance after one fresh, uncentrifuged sample showing azoospermia or ≤100,000 non-motile sperm (RNMS). Objective Therefore, we aimed to describe temporal trends in vasectomy volume, assess PVSA adherence, and evaluate procedural success at our tertiary center. Methods We performed a retrospective cohort study of all consecutive vasectomies conducted between January 2017 and April 2025 in our tertiary center. Data were retrieved from operating-room logs, electronic medical records, and fertility laboratory databases. The primary outcome was vasectomy success at first or repeat PVSA, defined as azoospermia or ≤100,000 RNMS. Data confidentiality was assured. Results A total of 430 vasectomies were performed. Median patient age was 41.5 years (IQR 37.6–45.6). Annual volumes were: 26 (2017), 14 (2018), 16 (2019), 16 (2020), 32 (2021), 40 (2022), 55 (2023), 181 (2024), and 50 (January–April 2025). Monthly case volume rose sharply from 1.6/month (2017–2019) to 15.1/month in 2024. PVSA adherence was 65.3% (281/430). Median time to first PVSA was 104 days (IQR 91–146). Clearance at first PVSA was achieved in 97.5%: 209 (76%) with azoospermia and 65 (24%) with RNMS. Four patients (1.4%) required repeat PVSA due to 100,000 non-motile sperm (n=2) or 100,000 motile sperm (n=2); all achieved azoospermia or RNMS on repeat testing. Vasectomy failure rate was 1.1%, as three patients required repeat vasectomy; all ultimately achieved azoospermia. Conclusions Vasectomy demand increased nearly tenfold over eight years, with high procedural effectiveness and minimal failure rates. However, PVSA adherence remained modest, indicating limited patient willingness to complete post-procedure testing. These findings highlight a gap between clinical recommendations and patient behavior. While PVSA remains a crucial safety step, alternative follow-up strategies or enhanced counseling may be needed to ensure compliance and maintain procedural safety. Disclosure No

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